Provider Demographics
NPI:1467954362
Name:VALETI, NARMADA (DDS)
Entity Type:Individual
Prefix:
First Name:NARMADA
Middle Name:
Last Name:VALETI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48720 BIG HORN CT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-7703
Mailing Address - Country:US
Mailing Address - Phone:814-954-2632
Mailing Address - Fax:
Practice Address - Street 1:1107 OCEAN ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2818
Practice Address - Country:US
Practice Address - Phone:831-227-2160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1044341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice